It Takes All of Us

Collaboration Between Physicians & Physical Therapists Is the Future of Medicine

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It's a well-known fact that as elderly people age, physical function declines. The natural deterioration of musculoskeletal systems in older adults can dramatically reduce quality of life, but perhaps even more importantly, it is strongly associated with increased hospitalization, disability, dependence, and mortality rates.r' This puts a significant strain on both elderly people and the health care systems serving them across the world, especially as the number of elderly adults increases.s With this in mind, it's vital that the American medical establishment recognize the links between functional limitation, disability, and illness in the elderly and develop methods to help patients maintain physical function as they get older. Of course, with a wide range of health conditions that contribute to physical decline, including sarcopenia, obesity, chronic pain, and cognitive decline, it's impossible to recommend a one-size-fits-all approach. However, as the medical establishment seeks to develop and refine a multilateral treatment strategy, preventative physical and occupational therapies have emerged as powerful tools to simultaneously mitigate a wide range of risk factors for functional decline in the elderly.'

Where Physical Therapy Fits In

Physical activity is strongly linked to overall health, longevity, and well-being in individuals ofall ages, but research indicates that it may become even more important as patients move past the age of 65.'But how do we encourage elderly adults to stay physically active as their muscles deteriorate, chronic disease enters their lives, balance becomes an issue, and cognitive decline keeps them sedentary? By implementing preventative physical therapy intervention in elderly patients' regular treatment plans, we can address each of these problems at the root and help patients maintain the baseline health levels required to stay active. In one 2015 study, 41o community-dwelling adults over 75 years of age were split into three groups. Two of the groups went through a functional task exercise or preventative physical therapy program, both administered by physical therapists, while members of the control group continued to receive their usual levels of care. Researchers asked participants to self-report their functional abilities on two questionnaires, before and after the year-long trial. While both the experimental and control groups declined in physical function over a year, the experimental group's rate of functional decline was slowed by two-thirds.' This research supports a growing body of evidence indicating the efficacy of physical therapy intervention in slowing down functional decline in the elderly. One 2016 review concluded that "supervised resistance and/or aerobic PA interventions significantly [improve] performance-based, composite PF outcomes among community dwelling older adults" and that supervised exercise programs administered by professionals can improve long-term physical function.'The more minutes of exercise participants engaged in per week, and the longer they adhered to the exercise program, the better the patients' outcomes were.

Proactive Intervention Is Key

We're guessing that the evidence described above comes as no surprise to most physicians. Physical therapy encourages physical activity by design, and physical activity has long been linked to health and well-being. But it's important for medical practitioners to note that exercise intervention is more effective before an elderly patient is injured than after. Mortality rates skyrocket after a patient falls the first time, and subsequent falls become far more likely. Therefore, it's recommended that all at-risk elderly patients be screened for functional ability and prescribed preventative physical therapy as needed. Mobility performance analyses, such as screens examining walking speed and balance, are excellent tools to find the patients who can benefit most from preventative therapy.'By steering patients who exhibit significant functional decline toward a comprehensive physical therapy program, we can dramatically reduce the individual and collective stress that aging poses to our population.



Chase |D, Phillips L|, Brown M. Physical Activity Intervention Efects on Physical Function Among Community-Dwelling Older Adultsr A Systematic Review and Meta-Analysis. Journal ofAging and Physical Activity. 20 I 7;25( l): r49'170. doi:10. t r23ljapa.20r6'0040. '1Siemonsma PC, Blom JW Hofstetter H, et al. The efectiveness offunctional task exercise and physical therapy as prevention of functional decline in conlmunity dwelling older people with complex health problems. BMC Geriatrics. 2018;18(l). doi:10.1186/s12877-018-0859-3. Reeves D, Pye S, Ashcroft DM, et al. The challenge ofageing populations and patient frailty: can primary care adapt? BMl. 2018i362:k3349. doi:10.1 136/bmj.k3349. aAnton SD, Woods AJ, Ashizawa T, et al. Successful aging: Advancing the science ofphysical independence in older adults. Ag€ing Research Reviews. 2015;24:304-327. doi:10.1016/j.arr2015.09.005.